Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney

Ikeda, Akihiko; Tsukada, Toru; Konishi, Takako; Matsuzaki, Kanji; Jikuya, Tomoaki; Hiramatsu, Yuji

doi:10.3400/avd.cr.14-00099

Cited by 10 publications

(9 citation statements)

References 7 publications

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“…6) This approach has the further advantage of reducing ischemic time if the surgeon needs to perform endarterectomy or to reimplant anomalous renal vessels. More recently, Ikeda et al 11) reported a particular case of ruptured AAA with HSK. They performed a transperitoneal approach in order to clamp immediately the aorta, that is difficult to obtain through the left retroperitoneal approach, recurring to renal isthmus division, without renal complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

Caridi

Massara

Greco

et al. 2015

Annals of Vascular Diseases

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Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. Keywords: horseshoe kidney, infrarenal abdominal aortic aneurysmIn 90% of cases computerized tomography (CT) gives the most detailed information about the morphology of HSK and the anatomic relationships between the kidney, its blood vessels, and the aneurysm. 2) Here we present our operative strategy to treat a patient affected by a voluminous symptomatic AAA associated with HSK, through a left retroperitoneal surgical approach. Case ReportA 67-year-old man with a history of hypertension, dyslipidemia and diabetes mellitus, reported to the emergency room complaining acute onset of abdominal pain, probably due to a rapid enlargement of the aneurysm diameters. Clinically, a pulsatile abdominal mass was observed. Computed tomography (CT) demonstrated an AAA measuring 6.68 cm × 5.74 cm in diameter, associated with a HSK, with the isthmus lying anterior to the aneurysm, containing functional parenchymal tissue (Fig. 1A). Three main left and one right renal arteries were detected through CT scan. One small accessory renal artery, arising from the aneurismal wall near to the inferior mesenteric artery origin was observed. Also, the presence of one small accessory renal artery arising from the right common iliac artery that presented a diameter of 31 mm and of a large renal accessory artery arising from the left common iliac artery were detected (Fig. 1B). Even if Ruppert and colleagues 3) reported that endovascular aneurysm repair with coiling of the renal accessory arteries can be performed safely in presence of HSK, we did not chose this option for our patient, in order to avoid possible complications, such as occlusion of accessory renal arteries with subsequent renal infarction and the development of type 2 endoleaks, that are reported in literature. 4) The rapid onset of abdominal pain leads us to opt an emergency operation. With the patient in the right semilateral position, we recurred to a left retroperitoneal approach on the retro-renal space, in order to avoid the kidney isthmus resection and urinary tract damage. The renal isthmus containing functional parenchymal tissue

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

Caridi

Massara

Greco

et al. 2015

Annals of Vascular Diseases

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“…512 Should open repair be required and CT imaging reveal that the horseshoe kidney is associated with a thin fibrous isthmus, a transperitoneal approach may be considered with division of the "isthmus." [513][514][515] A hybrid approach has been described using a bifurcated Dacron graft based off the external iliac artery to revascularize the horseshoe kidney, followed by EVAR. 516,517 Likewise, repair has also been described using a fenestrated endograft and snorkel grafts.…”

Section: Special Considerationsmentioning

confidence: 99%

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Chaikof

Dalman

Eskandari

et al. 2018

Journal of Vascular Surgery

1,982

1,478

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Important new recommendations are provided for the care of patients with an AAA, including suggestions to improve mutual decision-making between the treating physician and the patients and their families as well as a number of new strategies to enhance perioperative outcomes for patients undergoing elective and emergent repair. Areas of uncertainty are highlighted that would benefit from further investigation in addition to existing limitations in diagnostic tests, pharmacologic agents, intraoperative tools, and devices.

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“… 5 ) The potential need to bisect the kidney at the renal isthmus in order to gain access to the aorta may disrupt the collecting system, resulting in hemorrhage, hematoma formation in the retroperitoneum, and vascular prosthesis infection associated with urine leakage. 6 ) On the other hand, Osawa et al suggested that a retroperitoneal approach might be unsuitable when the ureters run from the renal pelvis at the lateral wall of the HSK to the posterior side of the pelvis, with the semicircular course of the ureters facing laterally. 7 ) If that is the case, the HSK cannot be turned medially over the aorta.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Repair of an Abdominal Aortic Aneurysm: Debranching with Endovascular Aneurysm Repair in a Patient with Horseshoe Kidney

Kin

Takano

Nakagawa

et al. 2017

Annals of Vascular Diseases

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Abdominal aortic aneurysm (AAA) with associated horseshoe kidney (HSK) poses a technical challenge when performing conventional open surgical repair because of possible complications including renal infarction, neuralgia, and collecting system disruption. Endovascular aortic repair (EVAR) is considered the first-line treatment for this pathology, allowing for aneurysm repair without isthmus bisection. However, whether to sacrifice commonly presenting aberrant renal arteries during EVAR is a point of controversy. We report a case in which hybrid repair was performed for AAA to preserve aberrant renal vasculature in a patient with HSK.

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Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney

Cited by 10 publications

References 7 publications

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Hybrid Repair of an Abdominal Aortic Aneurysm: Debranching with Endovascular Aneurysm Repair in a Patient with Horseshoe Kidney

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